A dermatologist, who is also a psychologist, offers insights and strategies to help struggling patients come to terms with that “stranger’s” face in the mirror. For some, it is a gradual, gnawing, insidious process. For others, it is a sudden awareness akin to falling into a frigid pool of water. Perhaps it occurs on a given morning at the bathroom mirror, or maybe when viewing a holiday photograph or video. Sometimes it is a brief glimpse at one’s reflection in a department store changing room mirror or mirror over the sink in a public restroom. But no matter when it happens, the realization that one’s own face, that objective image of self, has become so discrepant from the subjective self within can be primordially disturbing and unsettling. How can it be that our internal self-perceptions differ so markedly from that older person we now are forced to see? Facing the Man/Woman in the Mirror Staring at this image, one may ask, “Who is that stranger? This person cannot be me! This repugnant image is most certainly some cruel reincarnation of an older relative, someone from the generations that preceded me!” What has happened? Are we no longer young? How can that be? We basically feel young; we’re still vibrant, fresh, hungry, seeking and evolving. We are still filled with hopes, dreams and expectations. We are not willing to relinquish the perspective that there is ample “time” to travel life’s roads and fulfill our dreams. So in reality, this harsh moment is actually a realization about the fleeting nature of time. It is a sudden awareness that more time has passed than we have realized. It is a fear that our time to shine and climb our individual mountains may have passed. It can be an unnerving terror, a sense that our remaining time in this life may be insufficient to fully embrace and imbibe the fullness of life. This is the moment when we desperately feel the need to remember. It is the need to remember the people, places, and mostly, our face and the faces that have defined our youth and ongoing youthfulness. How Dermatologists Can Help The challenge for ourselves personally and as clinicians is to decide what is the best strategy to deal with the discrepancy between the “new older face” we see versus the “younger person” trapped within. I postulate that one of the most valuable things we do as cosmetic dermatologists is help our patients to remember specific critical aspects that defined the face of their youth and new beginnings. Once identified, we can often then help them choose and modestly restore some of these aspects. I further propose that even modest restoration of facial volume and facial contour, diminution of dynamic wrinkling and dyspigmentation, and improved luminescence can often be sufficient to rekindle youthful enthusiasm, emotional positivity,and hopefulness that all too often becomes obscured by aging skin, time and life events. The Mind-body Connection In general, the greater the discrepancy between what we objectively see and what we subjectively feel, the more difficult it is to maintain a positive self concept and a comfortable psychological equilibrium. In contrast, the closer one’s physical reality is to his/her inner experiential world, the less angst they are likely to experience in this arena. This is precisely why well chosen cosmetic interventions can be such powerful emotional interventions. They can, in many cases, immediately decrease or eliminate this discrepancy and therefore potentially alleviate anxiety and depression while improving psychological states and overall functioning. Making Adjustments: How Far to Go So how does one adjust to this “new you?” Is it best to “grin and bear it” or seek intervention? The answer may lie somewhere in the middle. Each of us and all of our patients reside at some point along on a broad continuum of skin care and aesthetic intervention. The continuum ranges from total neglect at one extreme to grotesque and bizarre augmentation on the other. The position we hold can and usually does vary as we move through life. The dilemma facing each of us is where we wish to position ourselves at any given point in our lives. Sometimes, the “shine” of a regularly applied topical retinoid or topical antioxidant is all that is necessary for satisfaction. For others, an appropriately chosen and skillfully performed cosmetic procedure can physically and emotionally move the individual back to their more youthful selves. Intervention Issues Cosmetic interventions should not be about creating a new person, but rather helping the person to remember some of the freshness and youthfulness of their years past. Is the Patient Really Ready? It is incumbent upon us, as ethical and responsible clinicians to hear and feel what our patients are asking for. This honest appraisal can make the decision regarding the intervention “Du Jour” much clearer. Du Jour is a reference to the point on the continuum of interest and readiness that we hold today. Remember, tomorrow is a new day, “I would never” often means maybe tomorrow! Consider the Patient’s ‘True Self’ The region of the face encompassing the area from the lateral canthi to the oral commisures is what I refer to as the triangle of intimacy. Facing what lies within. Where does the true self lie? What evokes acceptance, interest, passion, romance and connectedness? Is it perfect skin, absence of wrinkles, perfect breasts, six pack abs, great legs? Doomed for Disappointment Unfortunately, there are those who judge themselves and others simply by their packages. These are usually emotionally turmoiled, vacant and insecure individuals seeking to demonstrate their worth, attractiveness and prowess. They are often critical of others, berating them for their physical shortcomings. They encourage and sometimes demand aggressive interventions in pursuit of physical perfection according to societal dictated images and accoutrements of beauty. Sadly, trying to please these individuals it is an empty and fruitless pursuit. They frantically seek the perfect face or perfect body yielding only a brief interlude of elation followed by inevitable disappointment. Why are they inevitably disappointed? Because perfection is an illusion. Even at its best, it is an ephemeral transition to increasing imperfection. Making the Cognitive Shift What does it take to look beyond the face and face our new reality? Strength, focus, faith and intervention. Perhaps there is much to be learned from the serenity prayer. Ideally, we help by changing, augmenting, correcting or diminishing what is feasible, appropriate and affordable. Once this is accomplished, the equally important task of accepting what cannot or should not change begins. Essentially, there is a “cognitive shift” that must occur if satisfaction and happiness are to be achieved. The shift must be from “what is wrong or missing” to what is right and present.” Mirrors and photos should no longer be scrutinized for what is wrong. Instead, they should be more briefly perused for the cues of what is right. The “perkier” appearance achieved from upper face volume restoration can be a powerful cue reminding the individual of more youthful times. Softening the tear trough can ameliorate the tired drawn appearance that so often torments our patients. Once this cognitive and behavioral shift begins, it becomes possible to focus, accept and enjoy the newfound youthful aspects of our new face that in at least some respects, is reminiscent of our younger self. Succinctly stated, I believe it is best to take a good, long, hard look, and then begin the process I call “emotionally facilitative delusional thinking.” Translation — accentuate the positive while minimizing, denying and discarding the visual clutter that reminds us of the negative realities of aging. Accept what you must, deny the rest. Dr. Fried, who is a psychologist as well as a dermatologist maintains a private practice in Yardley, PA. Disclosure: Dr. Fried has no conflict of interest with any subject covered in this article.
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REMEMBER ME? HELPING PATIENTS COME “FACE TO FACE” WITH AGING
A dermatologist, who is also a psychologist, offers insights and strategies to help struggling patients come to terms with that “stranger’s” face in the mirror. For some, it is a gradual, gnawing, insidious process. For others, it is a sudden awareness akin to falling into a frigid pool of water. Perhaps it occurs on a given morning at the bathroom mirror, or maybe when viewing a holiday photograph or video. Sometimes it is a brief glimpse at one’s reflection in a department store changing room mirror or mirror over the sink in a public restroom. But no matter when it happens, the realization that one’s own face, that objective image of self, has become so discrepant from the subjective self within can be primordially disturbing and unsettling. How can it be that our internal self-perceptions differ so markedly from that older person we now are forced to see? Facing the Man/Woman in the Mirror Staring at this image, one may ask, “Who is that stranger? This person cannot be me! This repugnant image is most certainly some cruel reincarnation of an older relative, someone from the generations that preceded me!” What has happened? Are we no longer young? How can that be? We basically feel young; we’re still vibrant, fresh, hungry, seeking and evolving. We are still filled with hopes, dreams and expectations. We are not willing to relinquish the perspective that there is ample “time” to travel life’s roads and fulfill our dreams. So in reality, this harsh moment is actually a realization about the fleeting nature of time. It is a sudden awareness that more time has passed than we have realized. It is a fear that our time to shine and climb our individual mountains may have passed. It can be an unnerving terror, a sense that our remaining time in this life may be insufficient to fully embrace and imbibe the fullness of life. This is the moment when we desperately feel the need to remember. It is the need to remember the people, places, and mostly, our face and the faces that have defined our youth and ongoing youthfulness. How Dermatologists Can Help The challenge for ourselves personally and as clinicians is to decide what is the best strategy to deal with the discrepancy between the “new older face” we see versus the “younger person” trapped within. I postulate that one of the most valuable things we do as cosmetic dermatologists is help our patients to remember specific critical aspects that defined the face of their youth and new beginnings. Once identified, we can often then help them choose and modestly restore some of these aspects. I further propose that even modest restoration of facial volume and facial contour, diminution of dynamic wrinkling and dyspigmentation, and improved luminescence can often be sufficient to rekindle youthful enthusiasm, emotional positivity,and hopefulness that all too often becomes obscured by aging skin, time and life events. The Mind-body Connection In general, the greater the discrepancy between what we objectively see and what we subjectively feel, the more difficult it is to maintain a positive self concept and a comfortable psychological equilibrium. In contrast, the closer one’s physical reality is to his/her inner experiential world, the less angst they are likely to experience in this arena. This is precisely why well chosen cosmetic interventions can be such powerful emotional interventions. They can, in many cases, immediately decrease or eliminate this discrepancy and therefore potentially alleviate anxiety and depression while improving psychological states and overall functioning. Making Adjustments: How Far to Go So how does one adjust to this “new you?” Is it best to “grin and bear it” or seek intervention? The answer may lie somewhere in the middle. Each of us and all of our patients reside at some point along on a broad continuum of skin care and aesthetic intervention. The continuum ranges from total neglect at one extreme to grotesque and bizarre augmentation on the other. The position we hold can and usually does vary as we move through life. The dilemma facing each of us is where we wish to position ourselves at any given point in our lives. Sometimes, the “shine” of a regularly applied topical retinoid or topical antioxidant is all that is necessary for satisfaction. For others, an appropriately chosen and skillfully performed cosmetic procedure can physically and emotionally move the individual back to their more youthful selves. Intervention Issues Cosmetic interventions should not be about creating a new person, but rather helping the person to remember some of the freshness and youthfulness of their years past. Is the Patient Really Ready? It is incumbent upon us, as ethical and responsible clinicians to hear and feel what our patients are asking for. This honest appraisal can make the decision regarding the intervention “Du Jour” much clearer. Du Jour is a reference to the point on the continuum of interest and readiness that we hold today. Remember, tomorrow is a new day, “I would never” often means maybe tomorrow! Consider the Patient’s ‘True Self’ The region of the face encompassing the area from the lateral canthi to the oral commisures is what I refer to as the triangle of intimacy. Facing what lies within. Where does the true self lie? What evokes acceptance, interest, passion, romance and connectedness? Is it perfect skin, absence of wrinkles, perfect breasts, six pack abs, great legs? Doomed for Disappointment Unfortunately, there are those who judge themselves and others simply by their packages. These are usually emotionally turmoiled, vacant and insecure individuals seeking to demonstrate their worth, attractiveness and prowess. They are often critical of others, berating them for their physical shortcomings. They encourage and sometimes demand aggressive interventions in pursuit of physical perfection according to societal dictated images and accoutrements of beauty. Sadly, trying to please these individuals it is an empty and fruitless pursuit. They frantically seek the perfect face or perfect body yielding only a brief interlude of elation followed by inevitable disappointment. Why are they inevitably disappointed? Because perfection is an illusion. Even at its best, it is an ephemeral transition to increasing imperfection. Making the Cognitive Shift What does it take to look beyond the face and face our new reality? Strength, focus, faith and intervention. Perhaps there is much to be learned from the serenity prayer. Ideally, we help by changing, augmenting, correcting or diminishing what is feasible, appropriate and affordable. Once this is accomplished, the equally important task of accepting what cannot or should not change begins. Essentially, there is a “cognitive shift” that must occur if satisfaction and happiness are to be achieved. The shift must be from “what is wrong or missing” to what is right and present.” Mirrors and photos should no longer be scrutinized for what is wrong. Instead, they should be more briefly perused for the cues of what is right. The “perkier” appearance achieved from upper face volume restoration can be a powerful cue reminding the individual of more youthful times. Softening the tear trough can ameliorate the tired drawn appearance that so often torments our patients. Once this cognitive and behavioral shift begins, it becomes possible to focus, accept and enjoy the newfound youthful aspects of our new face that in at least some respects, is reminiscent of our younger self. Succinctly stated, I believe it is best to take a good, long, hard look, and then begin the process I call “emotionally facilitative delusional thinking.” Translation — accentuate the positive while minimizing, denying and discarding the visual clutter that reminds us of the negative realities of aging. Accept what you must, deny the rest. Dr. Fried, who is a psychologist as well as a dermatologist maintains a private practice in Yardley, PA. Disclosure: Dr. Fried has no conflict of interest with any subject covered in this article.
A dermatologist, who is also a psychologist, offers insights and strategies to help struggling patients come to terms with that “stranger’s” face in the mirror. For some, it is a gradual, gnawing, insidious process. For others, it is a sudden awareness akin to falling into a frigid pool of water. Perhaps it occurs on a given morning at the bathroom mirror, or maybe when viewing a holiday photograph or video. Sometimes it is a brief glimpse at one’s reflection in a department store changing room mirror or mirror over the sink in a public restroom. But no matter when it happens, the realization that one’s own face, that objective image of self, has become so discrepant from the subjective self within can be primordially disturbing and unsettling. How can it be that our internal self-perceptions differ so markedly from that older person we now are forced to see? Facing the Man/Woman in the Mirror Staring at this image, one may ask, “Who is that stranger? This person cannot be me! This repugnant image is most certainly some cruel reincarnation of an older relative, someone from the generations that preceded me!” What has happened? Are we no longer young? How can that be? We basically feel young; we’re still vibrant, fresh, hungry, seeking and evolving. We are still filled with hopes, dreams and expectations. We are not willing to relinquish the perspective that there is ample “time” to travel life’s roads and fulfill our dreams. So in reality, this harsh moment is actually a realization about the fleeting nature of time. It is a sudden awareness that more time has passed than we have realized. It is a fear that our time to shine and climb our individual mountains may have passed. It can be an unnerving terror, a sense that our remaining time in this life may be insufficient to fully embrace and imbibe the fullness of life. This is the moment when we desperately feel the need to remember. It is the need to remember the people, places, and mostly, our face and the faces that have defined our youth and ongoing youthfulness. How Dermatologists Can Help The challenge for ourselves personally and as clinicians is to decide what is the best strategy to deal with the discrepancy between the “new older face” we see versus the “younger person” trapped within. I postulate that one of the most valuable things we do as cosmetic dermatologists is help our patients to remember specific critical aspects that defined the face of their youth and new beginnings. Once identified, we can often then help them choose and modestly restore some of these aspects. I further propose that even modest restoration of facial volume and facial contour, diminution of dynamic wrinkling and dyspigmentation, and improved luminescence can often be sufficient to rekindle youthful enthusiasm, emotional positivity,and hopefulness that all too often becomes obscured by aging skin, time and life events. The Mind-body Connection In general, the greater the discrepancy between what we objectively see and what we subjectively feel, the more difficult it is to maintain a positive self concept and a comfortable psychological equilibrium. In contrast, the closer one’s physical reality is to his/her inner experiential world, the less angst they are likely to experience in this arena. This is precisely why well chosen cosmetic interventions can be such powerful emotional interventions. They can, in many cases, immediately decrease or eliminate this discrepancy and therefore potentially alleviate anxiety and depression while improving psychological states and overall functioning. Making Adjustments: How Far to Go So how does one adjust to this “new you?” Is it best to “grin and bear it” or seek intervention? The answer may lie somewhere in the middle. Each of us and all of our patients reside at some point along on a broad continuum of skin care and aesthetic intervention. The continuum ranges from total neglect at one extreme to grotesque and bizarre augmentation on the other. The position we hold can and usually does vary as we move through life. The dilemma facing each of us is where we wish to position ourselves at any given point in our lives. Sometimes, the “shine” of a regularly applied topical retinoid or topical antioxidant is all that is necessary for satisfaction. For others, an appropriately chosen and skillfully performed cosmetic procedure can physically and emotionally move the individual back to their more youthful selves. Intervention Issues Cosmetic interventions should not be about creating a new person, but rather helping the person to remember some of the freshness and youthfulness of their years past. Is the Patient Really Ready? It is incumbent upon us, as ethical and responsible clinicians to hear and feel what our patients are asking for. This honest appraisal can make the decision regarding the intervention “Du Jour” much clearer. Du Jour is a reference to the point on the continuum of interest and readiness that we hold today. Remember, tomorrow is a new day, “I would never” often means maybe tomorrow! Consider the Patient’s ‘True Self’ The region of the face encompassing the area from the lateral canthi to the oral commisures is what I refer to as the triangle of intimacy. Facing what lies within. Where does the true self lie? What evokes acceptance, interest, passion, romance and connectedness? Is it perfect skin, absence of wrinkles, perfect breasts, six pack abs, great legs? Doomed for Disappointment Unfortunately, there are those who judge themselves and others simply by their packages. These are usually emotionally turmoiled, vacant and insecure individuals seeking to demonstrate their worth, attractiveness and prowess. They are often critical of others, berating them for their physical shortcomings. They encourage and sometimes demand aggressive interventions in pursuit of physical perfection according to societal dictated images and accoutrements of beauty. Sadly, trying to please these individuals it is an empty and fruitless pursuit. They frantically seek the perfect face or perfect body yielding only a brief interlude of elation followed by inevitable disappointment. Why are they inevitably disappointed? Because perfection is an illusion. Even at its best, it is an ephemeral transition to increasing imperfection. Making the Cognitive Shift What does it take to look beyond the face and face our new reality? Strength, focus, faith and intervention. Perhaps there is much to be learned from the serenity prayer. Ideally, we help by changing, augmenting, correcting or diminishing what is feasible, appropriate and affordable. Once this is accomplished, the equally important task of accepting what cannot or should not change begins. Essentially, there is a “cognitive shift” that must occur if satisfaction and happiness are to be achieved. The shift must be from “what is wrong or missing” to what is right and present.” Mirrors and photos should no longer be scrutinized for what is wrong. Instead, they should be more briefly perused for the cues of what is right. The “perkier” appearance achieved from upper face volume restoration can be a powerful cue reminding the individual of more youthful times. Softening the tear trough can ameliorate the tired drawn appearance that so often torments our patients. Once this cognitive and behavioral shift begins, it becomes possible to focus, accept and enjoy the newfound youthful aspects of our new face that in at least some respects, is reminiscent of our younger self. Succinctly stated, I believe it is best to take a good, long, hard look, and then begin the process I call “emotionally facilitative delusional thinking.” Translation — accentuate the positive while minimizing, denying and discarding the visual clutter that reminds us of the negative realities of aging. Accept what you must, deny the rest. Dr. Fried, who is a psychologist as well as a dermatologist maintains a private practice in Yardley, PA. Disclosure: Dr. Fried has no conflict of interest with any subject covered in this article.
